Screener is present at the entrance of the facility

Screener has appropriate PPE worn (e.g. surgical mask is worn properly)

Patients were observed to be screened properly with infrared thermometer

Tape/Markers are intact and visible for patients to see

Appointment Check in Area

Desks during check - in are clean and clear of unnecessary items?

Employees have surgical masks properly worn?

Employees are observed to be performing hand hygiene and do not have gloves worn during patient interaction

Payment transactions occur one way - meaning the employee is not touching debit cards and giving it back to patient

Waiting Area

There are less than 5 people in the waiting area

All patients are displaying appropriate social distancing (more than 6 ft) apart. This may exclude Parent/Child/Caregivers

Patients have masks or a face covering worn

Clinic - Break Room - Pit Area

Hand sanitizers are appropriately stocked inside and outside exam rooms

PPE is properly stocked and available for health care personnel use

Exam room appears to be clean and ready for patient use

Staff is appropriately using surgical masks during shift

Healthcare providers have surgical masks and eye protection worn during visit with patient

Staff is observed to perform hand hygiene prior to entering and leaving patients room

Pit/Work area is clean and presentable (If there is open food in the pit area please put 'no')

Exiting the Facility

There is no overcrowding of patients as they exit the premises.

The hazardous waste storage rooms are closed and properly secured

Exiting appears safe with no object blocking the hallways and exiting pathways

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.